Extracorporeal shock wave lithotripsy in children - Efficacy, complications and long-term follow-up

Objectives: Extracorporeal shock wave lithotripsy (ESWL) is effective and s afe for the treatment of upper urinary tract calculi in adults. Some specul ations concerning possible damages from ESWL on the growing kidney have bee n raised. Methods: From January 1990 to December 1998, 64 children (30 girls and 34 b oys; 8 months to 15 years old, mean 5.6 years) with a total of 83 stones of the upper urinary tract were treated by ESWL (Lithostar). Preoperative eva luation included history, physical examination, routine blood tests, urinal ysis, urine culture, intravenous urography and optional renal scintigraphy. The impulse rate per treatment varied from 750 to 4,000 (mean 2,996). Afte r acute treatment, routine follow-up included renal ultrasound, blood press ure controls, laboratory tests and eventually plain film X-ray. Results: Successful fragmentation of the stones was achieved in all patient s. In 54% the patients were free of stones treated at the time of discharge . At 3 months after treatment radiographic studies showed no residual fragm ents in 80% of the treated children. 83% of the treated stones were cleared entirely. The remaining fragments were clinically insignificant. An averag e of 2.5 ESWL treatments per child in general anesthesia were required. Sto ne analysis showed 20 calcium oxalate, 38 calcium phosphate, 12 struvite, 2 uric acid and 9 cystine calculi. Ureteral stents were placed in 43%. No si gnificant urinary infection was seen under antibiotic prophylaxis. Only 3 c hildren showed a recurrence (1 x cystinuria with low compliance and 2 Xx st ruvite). There was no case of renal scarring. No change in renal function o r blood pressure was found compared to the preoperativ values. Hematuria an d proteinuria disappeared in all children who were free of stones. Renal ul trasound revealed no growth difference between treated and untreated renal units. Conclusions: In childhood, ESWL is an efficacious and safe treatment of sto nes of the upper Urinary tract. The long-term follow-up after ESWL with a s econd-generation lithotriptor did not show any signs of damage to the growi ng kidney. Sometimes repeated ESWL treatments are justified by the low rate of complications. Copyright (C) 2001 S. Karger AG, Basel.